- Do you know how your claims process for all of our products (in- or out-of-network, Tier 1 or Tier 2)?
- Do others - such as shockwave therapy providers or durable medical equipment suppliers - routinely provide services at your office/facility, and do they bill independently?
- Do all providers within your building or clinic belong to the same network?
- Do you and your back-up provider(s) participate in the same networks?
- Do you know the participation status of the facilities you utilize (such as outpatient surgery centers, satellite offices, hospitals)?
- Do you refer patients to other in-network providers when additional care is needed?
To check network status, visit our
Provider Directory or call Member Services at 1.888.324.2064. For more information, check these online tools:
Drug List Updates for July 1
In June, we will post the July 1 drug list updates. Changes will display in our online Drug List on July 1, 2014.
Communications for Drugs With a New Prior Authorization and/or Higher Cost Share
- We are in the process of sending letters to members who currently use some medications and their prescribing physicians.
- In many cases, these members are given until September 1, 2014 to make a change.
- This provides time for members to discuss options with their physicians.
Please review the drug list update for details about the July 1 changes and how changes affect members currently taking the medications.
Update Your Check/Remittance Mailing Address
If the mailing address or payee name is incorrect on your claims check or remittance, contact Claims Customer Service at 1.800.444.4558.
Medical Policy Update
We updated the following medical policies in mid-May:
To view the changes, access Medical Policy Updates from our Coverage Criteria/Medical Policy page.
Coverage for Diabetes-Related Services
Covered Without a Member Cost Share
Under the Affordable Care Act, these services process without a member cost share when delivered by in-network providers for those who have diabetes:
- A routine preventive physical examination, which includes routine screenings to see if a patient has diabetes
- Nutrition counseling for patients with type 2 diabetes
We also want members with diabetes to receive an annual eye exam to check for diabetic retinopathy, so we'll cover that at 100 percent, too.
Subject to Member Cost Shares
Other services related to the care of diabetes are covered but may be subject to applicable cost-share amounts. These services include:
- Evaluation and monitoring of ongoing medical conditions
- Investigating and diagnosing new symptoms
- Follow-up tests or appointments
- Office visits and lab work completed after the annual wellness exam
- Diabetes self-management training
- Routine foot checks
- Prescription drugs including insulin and diabetic supplies
Reminder: When a patient presents with more than one diagnosis or comorbidity, it is important to include all diagnoses on your claim.
Related Information
Do You Use a Billing Service?
When a billing service registers for secure website access to manage your administrative functions, we'll contact you:
- Before granting access for verification.
- Annually to ensure your relationship with the billing service continues.
These actions help safeguard your patient's protected health information (PHI) and avoid unnecessary delays or interruption in an appropriate billing service's access.
If your relationship with a billing service terminates, please call 1.855.699.6694 to revoke access.
Introducing Our New Member Magazine
Wonder what we share with members about their insurance? Then check out Connections, our first member magazine.
Connections will be mailed twice a year and posted on the public Member section of our website (see Member News). Printed on recycled paper, Connections includes required notices and information to help members understand more about their health plans.
You'll notice we've created three versions, each designed for a specific audience:
- Iowa Marketplace Choice Plan members
- Individual members
- Group members (those covered through their employer)
Newletters should arrive in member mailboxes over the next few days.
Contact Us
Have you checked out the new Contact Us link? The link provides:
- Phone numbers and hours (when available)
- Fillable forms that help us research your answer before we respond
- Links to website tools or pages
Look for Contact Us in the Help Center.
